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Flashcards in Random4 Deck (146):
1

normal jugular venous pressure?

2

normal jugular venous pressure?

3

teardrop shaped growths on vulva vestibule - think?

genital warts from HPV (condyloma acuminata)

4

condyloma acuminata caused by?

HPV

5

cluster of pink/skin-colored smooth teardrop lesions on vulva - think?

condyloma acuminata (genital warts) from HPV

6

condyloma lata is from?

2ndary syphilis

7

teardrop shaped growths on vulva vestibule - think?

genital warts from HPV (condyloma acuminata)

8

condyloma acuminata caused by?

HPV

9

cluster of pink/skin-colored smooth teardrop lesions on vulva - think?

condyloma acuminata (genital warts) from HPV

10

genital warts treat?

small :tricholoroacetic acid or prodophyllin

large: excision or fulguration (electric current)

11

condyloma lata is from?

2ndary syphilis

12

flat velvety lesions on vulva think?

condyloma lata (syphilis)

13

condyloma lata look?

flat velvety lesions on vulva

14

single fleshy lesion on labia majora -- think?

vulvar cancer

15

white thin wrinkled skin over labia + itchy - think?

lichen sclerosus

16

hyperkeratotic, erosive, or papulosquamous lesions in middle aged women w/ pruritus, soreness, and vag discharge -- think?

vulvar lichen planus

17

when pregnent pt has chronic HTN when?

systolic >140 and/or diastolic >90 PRIOR to conception or 20wks gestation

18

Chronic HTN w/ superimposed preeclampsia is?

Chronic HTN and 1 of following:
- new onset proteinuria/worsening proteinuria >=20wks
- sudden worsening of HTN
- Signs of end organ damage

19

new onset of elevated pressure >20 weeks gestation w/ no end organ issues?

gestation HTN

20

inc fetal risk w/ primary HTN preg are (4)?

- IUGR (asymmetric)
- Perinatal mortality
- Preterm delivery
- Oligohydramnios

21

treatment for benzodiazepine intoxication?

Flumazenil

22

Flumazenil treats what intoxication?

Benzodiazepine

23

Chronic HTN w/ superimposed preeclampsia is?

Chronic HTN and 1 of following:
- new onset proteinuria/worsening proteinuria >=20wks
- sudden worsening of HTN
- Signs of end organ damage

24

inc maternal risk w/ primary HTN are? (5)

- superimposed preeclampsia
- postpartum hemorrhage
- gestational DM
- Abruption
- C-section

25

beta blocker intoxication symp and treat w/?

- bradycardia + hypOtension + whezing
- glucagon

26

nL pupil size in bright light ?

2-4 mm

27

dilated pupil is ?

4-8mm

28

drowsiness + slurred speech + unsteady gate -- what intoxicated w/?

- alcohol
- benzos

29

glucagon used for what intoxication?

Beta-blocker inxociation

30

beta blocker intoxication symp and treat w/?

- bradycardia + hypOtension + whezing
- glucagon

31

what meds can cause extrapyramidal side effects?

those that block dopamine (D2) receptors.
- 1st gen Antipsychotics (ie halperidol)
- Some 2nd gen antipsychotics (ie risperidone)
- antiemetics (ie metoclopramide)

32

what may help w/ tardive dyskinesia?

clozapine

33

Extrapyramidal symps?

- acute dystonia (torticollis)
- Akathisia (restlessness)
- parkinsonism (tremor, rigidity, bradykinesia)
- Tardive dyskinesia

34

severe rigidity + mental status change + high fever + autonomic instability + psych meds - think?

neuroleptic malignant syndrome

35

treatment of akathisia (2)?

- propranolol
- lorazepam (benzo)

36

treatment of extrapyramidal symp -- > parkinsonisms? (2)

- benztropine
- Amantadine

37

what may help w/ tardive dyskinesia?

clozapine

38

lead pipe rigidity - think?

neuroleptic malignant syndrome

39

severe rigidity + mental status change + high fever + autonomic instability + psych meds - think?

neuroleptic malignant syndrome

40

hereditary angioedema due to?

C1 inhibitor deficiency

41

rapid onset of non-inflammatory edema of face, limbs, and genitalia, laryngeal edema, colicky abdominal pain w/ no evidence of hives (urticaria) -- think?

Hereditary angioedema

abdominal pain due to edema of intestines

42

c1 inhibitor deficiency or dysfuntion -->?

hereditary angioedema

43

immune hemolytic anemia and Rh hemolytic disease of new born what kind of hypersensitivity?

Ab mediated (type II)

44

C1 q levels differ how and why in hereditary vs acquired angioedema?

- Hereditary: C1q levels are normal
- Acquired: LOW c1q levels

45

cafe-au-lait spots, bilateral acoustic neuromas, cataracts - think?

neurofibromatosis type 2

46

what is elevated in hereditary angioedema?

C2b and bradykinin

47

serum sickness what type of hypersensitivity?

Immune complex mediate (type III)

48

immune hemolytic anemia and Rh hemolytic disease of new born what kind of hypersensitivity?

Ab mediated (type II)

49

cafe-au-lait spots, macrocephaly, feeding problems, short stature, and learning disabilities, lish nyhan spots- think?

Neurofibrimatosis 1

50

cafe-au-lait spots, bilateral acoustic neuromas, cataracts - think?

neurofibromatosis type 2

51

newborn w/ large flank masses + resp distress + flattened ears/nose + small jaw -- think?

Autosomal recessive polycystic kidney disease

flattened ears/nose and small jaw = Potter faces

52

Potter faces - think? is?

- flattened ears/nose
- micgrognathia (small jaw) from oligohydramnios

Think: Autosomal recessive polycystic kidney disease

53

kid w/ pertussis how to treat household contacts?

- Macrolide for all household contacts
REGARDLESS of vax status

54

myopathy is?

disease of muscle --> muscle weakness

55

what med associated w/ pyloric stenosis?

erythromycin use in babies

56

erythromycin associated w/ what GI complication?

pyloric stenosis if used in pts

57

when acellular pertussis vaccine given?

5 doses!
2,4,6, 15-18mo and 4-6yo

58

myotonia is?

inability to relax muscles after strenuous effort

59

myopathy is?

disease of muscle --> muscle weakness

60

myotonic dystrophy is inherited how?

Autosomal dominent

61

mytonic m. dystrophy cause?

expansion of CTG trinucleotide repeat on DMPK gene

62

comorbidities w/ duchenne?

- scoliosis
- cardiomyopathy

63

comorbidity w/ becker MD?

cardiomyopathy

64

comorbidities w/ myotonic m. dystrophy? (4)

- arrhythmias
- cataracts
- balding
- testicular atrophy/infertility

65

Duchenne and Becker inherited how?

X-linked recessive deletion of dystrophin gene

66

mytonic m. dystrophy cause?

expansion of CTG trinucleotide repeat on DMPK gene

67

hazard rate is?

the change of an event occuring in 1 of the study groups during a set period

68

hazard ratio is?

chance of an event occuring in a TREATMENT group compared to the chance of that event occurring in the CONTROL group during a set period

69

Hazard ratio

event more likely to occur in control group

(treatment likelihood/control likelihood)

70

hazard ratio >1 means?

event more likely to occur in the treatment group

(treatment likelihood/control likelihood)

71

confidence interval contains 1 means?

no significant difference between the 2 groups

72

Delta wave is?

upsloping just before QRS complex

73

Electrical alternans found on EKG in what cardiac case ?

Pericardial effusion

74

QRS complexes who amplitudes vary from beat to beat - is?

Electrical alternans

(think pericardial effusion)

75

f waves found?

F wave = flutter wave

Dx for atrial fluter

76

most common skin malignancy in gen pop?

basal cell carcinoma

77

Delta wave is?

upsloping just before QS complex

78

main cause of exertional heat stroke?

inadequate/failure of thermoregulation

- fluid and salt levels may contribute, but does not cause

79

squamous cell carcinoma common in?

Immunosuppresed pts (ie organ transplant)

80

pearly, flesh/pink colored nodule w/ telangiectatic vessels - think?

basal cell carcinoma

81

most common skin malignancy in gen pop?

basal cell carcinoma

82

immunosuppressed pt + multiple, discrete, flesh--red colored papules of varying size w/ slight central umbilication -- think?

Disseminated cryptococcosis

83

heat exhaustion vs heat stroke?

Exhaustion: inability to maintain adequate CO due to dehydration

Stroke: failure of thermoregulation

84

main cause of fever?

cytokine activation during inflammation

85

main cause of malignant hyperthermia?

uncontrolled efflux of Ca from sarcoplasmic reticulum

(rare autosomal dom disorder, pts receive halothane and succinylcholine for anesthesia --> hyperthermia)

86

heat exhaustion cause by?

inadequate Na and H2O replacement during physical activity

87

Heat exhaustion is?

inability to maintain adequate cardiac output

88

heat exhaustion vs heat stroke?

Exhaustion: inability to maintain adequate CO due to dehydration

Stroke: failure of thermoregulation

89

baker's cysts dev bc?

excessive fluid production by inflamed synovium --> accumulates in popliteal bursa
- associated w/ RA, OA, cartilage tears

90

resting tremor is?

low amplitude and freq tremor that dec w/ voluntary movement (so most pronounced when resting)

seen w/ parkinson's disease

91

Resting tremor associated w/?

parkinson's disease

92

which tremor is relieved w/ alcohol?

Essential tremor

93

parkinson disease due to?

loss of dopaminergic neurons in the basal ganglia

94

Intention tremors associated w/?

Cerebellar dysfunction

95

what tremor asociated w/ cerebellar dysfunction?

low freq (3-4 even lower than PD) INTENTION tremor (inc at end of intentional movement that is visually directed [ie reaching for something])

96

physiological tremors are what type?

postural (inc w/ sustained m. tone --> ie holding arms outstretched)

97

which tremors are worsened by emotional or physical stress or caffeine?

physiologic tremors

98

physiological tremor amp and freq?

low amplitude
high freq

99

resting tremor amp and freq?

low amp
low freq

100

physiological tremors are what type?

postural (inc w/ sustained m. tone --> ie holding arms outstreched)

101

which tremors are worsened by emotional or physical stress or caffeine?

physiologic tremors

102

substernal discomfort, left sided neck pain, diaphoresis, SOB that can wake a person up at night -- concern for?

acute coronary syndrome (ie MI, ischemia, etc)

103

during acute MI what new heart sound may be heard?

S4
(atrial gallop; due to atria contracting and forcing blood into stiff ventricle)

104

associated w/ S4? (4)

- HTN hear disease
- AS
- HOCM
- Acute MI

105

S3 nL in what pop? (3)

- kids
- young adults
- pregnancy

106

associated w/ S3? (3)

- Heart failure
- Restrictive cardiomyopathy
- High output states

107

nL pop to hear S4?

healthy OLDER adults

108

sharp pleuritic pain hurts worse w/ inspiration or coughing and dec when pt sits up and leans forward -- think?

Acute pericarditis

109

"ejection type systolic murmurs" - talking about what?

flow of bld across aortic and pulmonic valves

110

pulsus paradoxus found w/? (5)

- MAIN: Cardiac tamponade
- severe asthma
- COPD
- hypovolemic shock
- occasionally constrictive pericarditis

111

best imaging for acoustic neuromas?

MRI w/ gadolinium

112

sharp pleuritic pain hurts worse w/ inspiration or coughing and dec when pt sits up and leans forward -- think?

Acute pericarditis

113

post ictal acidosis treatment?

Should be transient and self resolves w/in 60-90 minutes

114

cardiac and vascular response to dopamine?

Dopamine is:
- positive inotrope (inc contraction strength)
- vasoconstrictor

115

best imaging for acoustic neuromas?

MRI w/ gadolinium

116

high anion gap metabolic acidosis post grand mal seizure - likely cause?

lactic acidosis

117

post ictal acidosis treatment?

Should be transient and self resolves w/in 60-90 minutes

118

proptosis is?

bulging of eye

119

flash pulm edema in MI setting - treat?

furosemide

120

what indicates an MI pt that would NOT receive beta blockers?

- Bradycardia
- Decompensated CHF (ie flash pulm edema)

121

if left untreated hypERthyroidism maj effect?

- Bone loss --> osteoporosis, hyperCalcemia, and hypercalciuria

122

proptosis is?

bulging of eye

123

fetal hyperthyroidism seen w/ what thyroid disease?

Graves disease
- TSH receptor Ab cross the placenta affecting fetal thyroid

124

carotid pulse w/ dual upstroke - thinkn?

HOCM

125

systolic ejection murmur along L sternal border w/ strong apical pulse - think?

HOCM

126

valsalva inc what murmurs (2)?

HCM
MVP

127

standing inc what murmurs?

HCM
MVP

128

Squatting inc what murmurs (3)?

AR
MR
VSD

129

Squatting dec what murmurs (2)?

HCM
MVP

130

handgrip --> what?

inc afterload
inc BP

131

handgrip inc what murmurs? (3)

AR
MR
VSD

132

What maneuvers inc preload? (2)

- Squatting from standing (inc afterload too)
- Passive leg raise

133

blunt trauma + pneumomediastinum + persistent pneumothorax + subQ emphysema - think?

Bronchial rupture (usually R)

134

what maneuvers dec preload (3)?

-valsalva (straining phase)
- Abrupt standing
- Nitro admin

135

What maneuvers inc afterload? (2)

- Hand grip
- Squatting (from standing; also inc preload)

136

What maneuvers inc preload? (2)

- Squatting from standing (inc afterload too)
- Passive leg raise

137

cerebellar gait?

ataxic: staggering, wide based gait

can see swaying side to side and impaired tandem gait

138

foot drop due to issue w/?

common peroneal nerve

(L5 radiculopathy)

139

peroneal neuropathy due to?

compression of the nerve at the lateral aspect of the fibula

140

peroneal neuropathy associated w/

sensory loss over dorsum of food

141

vestibular gait?

unsteady fall to one side

vertigo

142

gait apraxia/frontal gait?

Magnetic (freezing): start and turn hesitation

143

when do you see gait apraxia?

- frontal lobe issue
- NPH

144

parkinson gait?

short steps, shuffling

145

vestibular gait?

unsteady fall to one side

vertigo

146

Corrected Ca = ?

Corrected Ca = (measured total Ca) + (0.8*[4 g/dL - serum albumin in g/dL])